Healthcare Provider Details

I. General information

NPI: 1174043525
Provider Name (Legal Business Name): DYAMIC NEUROMONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W GLORIA SWITCH RD
LAFAYETTE LA
70507-3409
US

IV. Provider business mailing address

PO BOX 91180
LAFAYETTE LA
70509-1180
US

V. Phone/Fax

Practice location:
  • Phone: 337-886-5440
  • Fax: 337-886-9983
Mailing address:
  • Phone: 337-886-5440
  • Fax: 337-886-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RON NEZAT
Title or Position: CEO
Credential:
Phone: 337-886-5440